The authors research question was: ‘Which criteria are used to determine when the patient can return to running following primary ACL reconstruction?’
Discussion In this scoping review that included 201 articles, time was the most frequently reported criterion for clearing patients to RTR after primary ACL reconstruction. The median time for clearance to RTR was 12 postoperative weeks (IQR=3.3, range 5–39 weeks). The time criterion for RTR has changed over the years mirroring changes in rehabilitation approaches. Fewer than one in five studies reported clinical, strength or performance-based criteria for RTR, the most frequently reported being: full knee RoM or >95% of the non-injured knee; pain <2 on visual analogue scale; isometric lower limb strength LSI>70%; isokinetic quadriceps and hamstring strength LSI>70%; and hop test LSI>70%.
Clinical criteria are important indicators of adequate loading when returning to running
We suggest that these clinical criteria: pain <2 on visual analogue scale, 95%knee flexion RoM (side to side difference), full extension RoM (0° knee extension), no effusion/trace of effusion, should be used as ‘non-negotiable’ clinical milestones for RTR—patients must fulfil these criteria before RTR as a way to ensure adequate loading.
We propose the term return-to-running activities to describe the phase of RTR at a slow speed (8–10km/ hour), but it may be relevant to establish consensus on the definition of the term ‘running’. Since authors report general criteria that governed rehabilitation progression, our analysis of the time-based criteria reflects a general time frame, instead of the precise time each patient was permitted to RTR in each study.
What are the new findings?
► Only one in five studies reported clinical, strength or performance-based criteria for return to running (RTR).
► The most cited time-based criterion for RTR was 12 postoperative weeks.
► An approach combining assessment goal-based criteria with time-based criteria is a reasonable approach for RTR after ACL reconstruction.